NPIMap

Organization Active NPI

Phoenix Id LLC

  • Infectious Disease Physician
  • Phoenix, AZ
National Provider Identifier
1205027646
Registry record updated Oct 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
37316 Issued in AZ
Legal business name
PHOENIX ID LLC
Practice address
340 E Palm LN Ste 100
Phoenix, AZ 85004-4528
Phone
(602) 254-1136
Fax
(602) 272-1720
NPI assigned
Aug 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacob Oommen, MDNPI 1720020431
Title
Owner
Phone
(480) 907-7786

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RI0200X 37316 AZ Primary

Addresses

Primary practice location

340 E Palm LN Ste 100
Phoenix, AZ 85004-4528

Mailing address

3303 S Lindsay Rd Ste 123
Gilbert, AZ 85297-2100
Phone (480) 821-9339

National Provider Directory

National Provider Directory

Locations

340 E Palm Ln
Ste 100
Phoenix, AZ 85004
Phone (602) 254-1136

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223510400000",
    "number": "1205027646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3303 S LINDSAY RD STE 123",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852972100",
            "telephone_number": "480-821-9339",
            "fax_number": "480-821-9555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 E PALM LN STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850044528",
            "telephone_number": "602-254-1136",
            "fax_number": "602-272-1720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX ID LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-08",
        "last_updated": "2008-10-09",
        "status": "A",
        "authorized_official_last_name": "OOMMEN",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-907-7786",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "AZ",
            "license": "37316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.